Pharm II - Test 3 Flashcards
(182 cards)
1
Q
Class: Levothyroxine (Synthroid)
A
Thyroid hormone replacement (synthetic T4)
2
Q
Indication: Levothyroxine (Synthroid)
A
Hypothyroidism, TSH suppression in select cases of thyroid nodules and thyroid cancer
3
Q
Side effects: Levothyroxine (Synthroid) and Thyroid USP (Armour) and Liothyronine (Cytomel)
A
Palpitations, tachycardia, intolerance to heat, anxiety
Long-term elevation of serum T4 may accelerate cardiac disease and osteoporosis
4
Q
What is an important contraindication for patients with Addison’s disease and hypothyroidism take Synthroid or Armour thyroid?
A
Replacing thyroid hormone before replacing cortisol can be fatal.
5
Q
Equivalent dosing: Armour vs. Synthroid vs. Cytomel
A
60 mg (1 grain) Armour = 100 mcg of T4 (Levothyroixine/Synthroid) = 25 mcg of T3 (Triiodothyronine/Cytomel)
6
Q
Indication: Thyroid USP (Armour)
A
Hypothyroidism
7
Q
MOA: Thyroid USP (Armour)
A
Replaces both T4 and T3
8
Q
Thyroid USP (Armour) is standardized to ___
A
iodine content (0.2% iodine)
9
Q
With what population should you use more cautious dosing of thyroid replacement?
A
Patients over 65 with a history of cardiac disease
10
Q
Class: Liothyronine (Cytomel)
A
Thyroid hormone replacement (synthetic T3) dosed in mcg
11
Q
Indication: Liothyronine (Cytomel)
A
Hypothyroidism with intolerance to T4 replacement therapy or no improvement on T4 replacement therapy
Myxedema coma
“Wilson’s syndrome”
12
Q
Condition caused by excess administration of thyroid hormone
A
Thyroiditis factitia
13
Q
Thyroid conditions can place patients at greater risk for ___(2).
A
Osteoporosis
Cardiac disease
14
Q
What type of drugs are often used to block the signs and symptoms of hyperthyroidism?
A
Beta blockers
15
Q
Class: Methimazole (Tapazole)
A
Thionamide
16
Q
Indication: Methimazole (Tapazole)
A
Hyperthyroidism
17
Q
MOA: Methimazole (Tapazole)
A
Inhibits transformation of inorganic iodine to organic iodine -> blocks production of thyroxine
Inhibits coupling of iodotyrosine to form T3/T4
Minimal effect blocking peripheral conversion of T4 to T3
18
Q
Contraindications: Methimazole (Tapazole), Propylthiouracil (PTU)
A
Pregnancy - Propylthiouracil (PTU) is considered safer (category D)
19
Q
Class: Propylthiouracil (PTU)
A
Thionamide
20
Q
Indication: Propylthiouracil (PTU)
A
Hyperthyroidism
21
Q
MOA: Propylthiouracil (PTU)
A
Inhibits transformation of inorganic iodine to organic iodine -> blocks production of thyroxine
Inhibits coupling of iodotyrosine to form T3/T4
Blocks peripheral conversion of T4 to T3
22
Q
MOA: Methimazole (Tapazole) vs Propylthiouracil (PTU)
A
Propylthiouracil (PTU) has a greater effect on blocking peripheral conversion of T4 to T3
23
Q
Indication: Iodine (SSKI)
A
Hyperthyroidism, thyroid storm
24
Q
MOA: Iodine (SSKI)
A
Large doses of iodine inhibit release of thyroxine from thyroid gland
25
Beneficial effects of Iodine (SSKI) generally last no more than ___.
2-3 weeks
26
Indication: Radioactive iodine (131I)
Hyperthyroidism, Selected cases of thyroid cancer, thyroid nodules
27
Side effects: Radioactive iodine (131I)
Tenderness, swelling during initial week, N/V
transient BM depression and acute leukemia w/ extremely high doses
M - dec sperm, temp. infertility (~2 years)
28
Preparation for treatment with Radioactive iodine (131I)
Euthyroid state achieved by anti-thyroid drugs or SSKI
29
Contraindications: Radioactive iodine (131I)
Category X (delay 6-12 mos after tx)
30
SSx: Thyroid storm
High fever, irritability, delirium, V/D, dehydration, hypotension, vascular collapse
Coma, death
31
Which population is at risk for thyroid storm unless anti-thyroid medication has been administered?
Patients undergoing surgery for hyperthyroidism
32
Tx: Thyroid storm
Beta blockade + IV Iodine
33
Dx: DM
Confirmed fasting blood glucose level of >/= 126 mg/dl
Non-fasting blood glucose of >/= 200 mg/dl in pt presenting w/ sxs or exam findings consistent with DM
34
Concordance for development in identical twins: Type I vs II diabetes
Type I: 50%
Type II: 90-100%
35
What antibody testing should be considered in all non-obese adults who present with sxs of type II diabetes (type 1.5)?
Islet cell, insulin, and glutamic acid decarboxylase antibodies
36
MOA: Metformin vs. Sulfonylureas/Meglitinides vs. Alpha-glucosidase inhibitors vs. Thiazolidinediones (Glitazones) vs. DPP-4 inhibitors
Metformin = inhibits hepatogluconeogenesis, dec insulin resistance
Sulfonylureas/Meglitinides = inc secretion of insulin (secretagogues)
Alpha-glucosidase inhibitors = delay absorption of glucose by intestines
Thiazolidinediones (Glitazones) = dec insulin resistance (via PPAR-gamma)
DPP-4 inhibitors = promote release of insulin from pancreas after eating a meal (via GLP-1)
37
Class: Metformin (Glucophage)
Biguanides
38
MOA: Metformin (Glucophage)
Dec hepatic glucose production, inc insulin sensitivity in skeletal muscle
39
Pregnancy and Metformin (Glucophage)
Category B
40
Side effects: Metformin (Glucophage)
Abdominal cramping, N, metallic taste, inc risk for B12 deficiency
Lactic acidosis (rare)
41
Contraindications: Metformin (Glucophage)
Do not use in pts w/ impaired renal fxn (serum creatinine >1.5 mg/dl in M or >1.4 in F)
42
MOA: Sulfonylureas
Interaction w/ ATP-sensitive K channel in the beta cell membrane -> inc. insulin production from intact beta cells (secretagogues)
43
What is the MC side effect of sulfonylureas?
Weight gain
44
In general, sulfonylureas become ineffective within ___.
5-10 years
45
Contraindications: Sulfonylureas
Patients w/ sulfa allergy
46
2nd-generation sulfonylureas (3)
Glipizide (Glucotrol)
Glyburide (Micronase, Diabeta)
Glimepiride (Amaryl)
47
MOA: Meglitinides
Interaction w/ ATP-sensitive K channel in the beta cell membrane -> Inc. insulin release from beta cells (secretagogues)
48
Meglitinides (2)
Nateglinide (Starlix)
| Repaglinide (Prandin)
49
Which meglitinide has been shown to be equally effective to the sulfonylureas?
Repaglinide (Prandin)
50
Side effects: Sulfonylureas, Meglitinides
Hypoglycemia, weight gain
51
Contraindication: Meglitinides
Do not combine with sulfonylurea drugs due to increased risk for hypoglycemia
52
MOA: Thiazolidinediones / Glitazone
Affect gene expression of PPAR gamma -> dec. peripheral insulin resistance, dec. hepatic glucose production
53
What is the only glitazone approved for concurrent use with insulin?
Pioglitazone (ACTOS)
54
TZDs/Glitazones (2)
Rosiglitazone (Avandia)
Pioglitazone (ACTOS)
55
Side effects: TZDs/Glitazones
Increased risk of CHF, MI(?), bone fractures, weight gain, ALT elevation
56
Alpha-glucosidase inhibitors (2)
Acarbose (Precose)
Miglitol (Glyset)
57
MOA: Alpha-glucosidase inhibitors
Inhibit alpha-glucosidase -> delays absorption of glucose and other monosaccharides
58
Alpha-glucosidase inhibitors can increase the risk for hypoglycemia when combined with ___.
Sulfonylureas
59
Contraindications: Alpha-glucosidase inhibitors
Pts w/ chronic intestinal dz, IBD, colonic ulceration, intestinal obstruction
60
Pregnancy: Alpha-glucosidase inhibitors
Category B
61
MOA: Sitagliptin (Januvia)
Dipeptidyl peptidase 4 (DPP-4) inhibitor -> prevent breakdown of GLP-1 and GIP -> potentiate secretion of insulin, suppress glucagon release -> normalize blood glucose
62
Side effects: Sitagliptin (Januvia)
Hypoglycemia
Inc. risk of acute/chronic pancreatitis
63
Indication: Pramlintide (Symlin)
Type 1 or 2 diabetes pts who are not achieving their A1c goal levels
First drug for type I since 1920s
64
Contraindication: Pramlintide (Symlin)
Cannot be combined with insulin
65
Side effect: Pramlintide (Symlin)
NAUSEA, modest weight loss
No hypoglycemia or weight gain
66
Rapid-acting insulin
Lispro (Aspart)
Humulog (Novalog)
67
Short-acting insulin
Regular Insulin (Humulin R)
68
Intermediate-acting insulin
NPH (Humulin N)
69
Long-acting insulin
Glargine (Lantus)
70
Insulin type for sleeping hours
Glargine (Lantus)
71
Insulin type before meals
Lispro (Aspart)
72
Side effects: Insulin
Weight gain, hypoglycemia (seizures, coma, death), hypokalemia, fibrotic/atrophic injection sites
73
Indication: Glucagon
Severe hypoglycemia
74
MOA: Glucagon
Stimulation of glucagon receptor sites -> increased glucose levels from hepatic breakdown
75
When prescribing Metformin to a pre-diabetic/diabetic women of child-bearing age who have been unable to become pregnant, be conscious that ___.
Prescription of OCs may be needed to prevent pregnancy
76
A person with a Dexa scan T-score of -1 has __ the risk of a normal 40 year old. -2? -3?
- 1 has 2x the risk
- 2 has 4x the risk
- 3 has 8x the risk
77
T -1 or higher = ___
Normal
78
T -2.5 to -1 = ___
Osteopenia
79
T below -2.5 = ___
Osteoporosis
80
T below -2.5 plus bone fragility = ___
Severe osteoporosis
81
Risk factors: Osteoporosis
F, Small/thin body stature, increased age, Caucasian/Asian, FHx, diet low in Ca/Vit D, Low E(F), Low T(M), inactive lifestyle, smoking, excess EtOH, glucocorticoids, anticonvulsants
82
Side effects: Calcitriol (Rocaltrol)
Inc. serum calcium levels
83
Indication: Calcitonin (Mialcin)
Treatment of osteoporosis
84
Indication: Raloxifene (Evista)
Treatment and prevention of osteoporosis
Reduce risk of breast cancer
85
Class: Raloxifene (Evista)
Selective estrogen receptor modulator (SERM)
86
MOA: Bisphosphanates
Inhibit osteoclast activity - inc. bone mass
87
Indication: Bisphosphanates
Treatment and/or Prevention of osteoporosis
88
Side effect: Alendronate (Fosamax)
Heartburn, N, ESOPHAGITIS, OSTEONECROSIS OF THE JAW, ATYPICAL FEMUR FRACTURES, myalgia
89
Class: Alendronate (Fosamax)
Bisphosphanate
90
Indication: Alendronate (Fosamax)
Prevention and Treatment of osteoporosis
91
MOA: Alendronate (Fosamax)
Inhibition of osteoclast activity
92
MOA: Raloxifene (Evista)
Binding to select estrogen receptor sites
93
Contraindications: Raloxifene (Evista)
Pregnancy, lactating women, women with active/hx of DVT/PE/renal vein thrombosis
94
Class: Calcitonin (Miacalcin)
Synthetic hormone from parathyroid gland
95
MOA: Calcitonin (Miacalcin)
Inhibition of osteoclast activity
96
Class: Teriparatide (Forteo)
Synthetic PTH analogue
97
Indication: Teriparatide (Forteo)
Treatment of osteoporosis
98
MOA: Teriparatide (Forteo)
Activates bone turnover, stimulates new bone formation in spine/hip
99
Teriparatide (Forteo) can be used for how long?
Up to 2 years
100
When estrogen is taken alone, it can increase a woman's risk of ___.
endometrial cancer
101
What is usually combined with estrogen in HRT to mitigate the risk for cancer?
progestin hormone
102
What is Prempro?
HRT (mix of estrogen and progestin)
103
Prempro has been linked to increased risk for ___.
MI, stroke, DVT/PE, breast cancer
104
Indication: Denosumab (Prolia)
Osteoporosis (tx), bone metastases, RA, MM, giant cell tumor
105
MOA: Denosumab (Prolia)
inhibits RANKL -> RANK not activated on pre-osteoclasts -> osteoclasts not formed
106
Route: Denosumab (Prolia)
SQ, every 6 mos
107
Indication: Estrogen in postmenopausal women
Symptoms of menopause (hot flashes, night sweats, tissue atrophy (vulva, vagina, urethra), insomnia, osteoporosis)
108
BiEst is a combination of ___
estriol, estradiol (80:20)
109
TriEst is a combination of ___
estriol, estradiol, estrone (80:10:10)
110
Bio-identical estrogen has been shown to decease risk of ___ compared to synthetic estrogen.
blood clots
111
Indications: Conjugated estrogens (Premarin)
Prevention/Tx of osteoporosis, post-menopausal sxs (hot flashes, vaginal dryness, itching)
112
Premarin is a combination of ___
conjugated estrogens (estrone, equillin)
113
MOA: Conjugated estrogens (Premarin)
Alters gene transcription
114
___ should be added to estrogen HRT in ____.
Progesterone
Women who have NOT undergone a hysterectomy
115
Side effects: Conjugated estrogens (Premarin)
vaginal bleeding, breast tenderness/pain, inc. risk of DVT, inc. risk of atherosclerosis and CAD, inc. risk of uterine and breast CA, inc. breast size,
116
Contraindications: Conjugated estrogens (Premarin)
Hx of DVT, breast CA, ovarian CA, uterine CA
Category X
117
Class: Medroxyprogesterone (Provera)
Synthetic progresterone
118
Indications: Medroxyprogesterone (Provera)
Contraceptive, HRT, DUB, endometriosis
119
MOA: Medroxyprogesterone (Provera)
Alters gene transcription
120
Contraindications: Medroxyprogesterone (Provera)
Hx of DVT, breast CA, ovarian CA, uterine CA
Category X
121
Class: Pramlintide (Symlin)
Amylin agonist analogs
122
MOA: Pramlintide (Symlin)
Slows gastric emptying, suppresses glucagon production and release
123
Class: Exenatide (Byetta)
Incretin (GLP-1) mimetics
124
MOA: Exenatide (Byetta)
Enhance glucose-dependent insulin secretion, suppress glucagon secretion, slow gastric emptying
125
MOA: Estrogen vs. Progestin in OCs
Estrogen suppresses ovulation
Progestin prevents implantation in the endometrium via inhibition of gonadotropin secretion
126
Dosages of E vs. P in OCs
Constant dose of E over 21 days
Increasing, triphasic dose of P over 21 days
127
OCs may lower the risk for what type of cancer?
Colorectal, Ovarian, Endometrial
128
What is a "mini-pill"?
Progestin-only OC
129
Drugs that can reduce the efficacy of OCs when used concurrently?
Penicillin, Amoxil, Tetracycline, Cephalosporins, Sulfa drugs, seizure drugs, St. John's wort
130
The use of OCs for 5 years or more dec. risk of ovarian cancer later in life by __.
50%
131
The use of OCs for 10 years or more dec. risk of ovarian cancer and endometrial cancer later in life by __.
80%
132
Class: Drospirenone (Yaz, Yasmin)
Anti-androgenic synthetic progestin
133
Depo-Provera is a injectable contraceptive given ___
4 times per year
134
Class: Depo-Provera
Progestin-only injectable contraceptive
135
MOA: Depo-Provera
Dec. GnRH release -> Dec FSH and LH - inhibition of follicular development and ovulation
136
Depo-Provera has been shown to reduce the risk of endometrial cancer by up to ___.
80%
137
Side effects: Depo-Provera
Menstrual irregularities, abd. discomfort, weight changes, HA, hair loss, fatigue, depression, nervousness, DELAYED RETURN OF FERTILITY
BONE LOSS, INC RISK FOR OSTEOPOROSIS
138
How long does it take for fertility to return after discontinuation with Depo-Provera?
9-10 months
139
What does the black box warning for Depo-Provera say?
Do not use for > 2 years dt concerns over bone loss
140
Class: Implanon
Implantable progestin contraceptive
141
Implanon is inserted (location) and must be removed within ___.
Inner arm
3 years
142
Class: Ortho Evra
Transdermal patch contraceptive
143
Contraindications: Nuva ring
Risk of blood clots
144
MOA: Paragard
Impairs mobility of sperm
Irritates endometrial lining -> inhibits implantation
145
MOA: Mirena, Liletta, Skyla
Release of long-acting synthetic progestin (Levonorgestrel) -> diminish frequency of ovulation and changes in cervical mucosa -> dec. implantation
146
Ingredients: Plan B, Next Choice
Progestin-only (Levonorgestrel)
147
Class: Ulipristal acetate (Ella)
Selective progesterone receptor modulator (SPRM)
148
Indication: Ulipristal acetate (Ella)
Emergency contraception
149
MOA: Ulipristal acetate (Ella)
Delay/inhibition of ovulation and inhibition of follicle rupture
150
Which form has been shown to be more effective as a morning after pill: combination or progestin-only?
Progestin-only
151
Class: Mifepristone (Mifeprex)
Synthetic steroid abortifacient
152
MOA: Mifepristone (Mifeprex)
Progesterone receptor antagonist w/ partial agonist activity, dec. human chorionic gonadotropin levels -> dec. progesterone production by corpus luteum
153
Contraindications: Mifepristone (Mifeprex)
Presence of IUD, ectopic pregnancy, known hemorrhagic d/o, on anticoagulant therapy, on long-term prednisone therapy
154
Class: Clomiphene (Clomid)
Estrogen receptor agonist
155
Indications: Clomiphene (Clomid)
Infertility, amenorrhea
156
MOA: Clomiphene (Clomid)
Binds to E receptor sites in brain -> interferes w/ normal negative feedback of E on GnRH -> inc secretion of GnRH -> inc release of LH and FSH -> ovulation
157
Side effects: Clomiphene (Clomid)
Vaginal dryness, vaginal bleeding, breast tenderness, anxiety, hot flashes
MULTIPLE BIRTHS
158
Contraindications: Clomiphene (Clomid)
Prior hx of LV dz, breast cancer, or uterine cancer
159
How long can Paragard be used?
10 years
160
Dosage of Levonorgesetrel: Mirena vs. Liletta vs. Skyla
Mirena = 52 mg (20 mcg/d)
Liletta = 52 mg (20 mcg/d)
Skyla = 13.5 mg (14 mcg/d)
161
How long can Mirena/Liletta be used?
5 years
162
How long can Skyla be used?
3 years
163
Indications: Exogenous T
Anemia, severe osteoporosis, hormone therapy for transsexual men
164
Side effects: Testosterone (M)
Acne, baldness, gynecomastia, priapism, inc. risk of prostatic hyperplasia and PrCa, worsening of sleep apnea, dec. sperm count/infertility, fluid retention/edema
165
Side effects: Testosterone (F)
Virilization (excess body/facial hair), acne, deepening of voice, clitoral enlargement, menstrual irregularities
166
Effect on Labs: Testosterone
Inc. LDL, dec. HDL, Inc. RBC
167
MOA: Testosterone
Alters gene transcription
168
MC indication of anti-androgen treatment?
Prostate cancer
169
Normal growth of prostate tissue is regulated by ___(2).
T, DHT
170
Class: Leuprolide (Lupron)
Anti-androgenic hormone, anti-estrogenic hormone
171
Indications: Leuprolide (Lupron)
Prostate cancer, precocious puberty, endometriosis, uterine fibroids, IVF
172
MOA: Leuprolide (Lupron)
GnRH agonist -> downregulation of FSH and LH -> dec. T/E
173
Indication: Finasteride (Proscar)
BPH, male-pattern baldness, PrCa
174
MOA: Finasteride (Proscar)
Limits conversion of T to DHT via inhibition of type II 5-alpha reductase
175
Side effects: Finasteride (Proscar)
Dec. libido, ED, impotency, depression, breast swelling, breast tenderness
176
Class: Sildenafil citrate (Viagra)
PDE5 inhibitor
177
Indications: Sildenafil citrate (Viagra)
ED, pulmonary HTN
178
MOA: Sildenafil citrate (Viagra)
Inhibition of PDE5 enzyme that degrades cGMP in the SM cells lining the blood vessels of the penis -> blood remains in penis -> erection maintained
179
Contraindications: Sildenafil citrate (Viagra)
Concurrent use w/ NO donors, organic nitrites/nitrates (nitroglycerin)
CV risk factors (recent stroke, heart attack)
Severe impairment of LV or KD fxn
Hypotension
Hereditary degenerative retinal d/o
180
Side effects: Sildenafil citrate (Viagra)
HA, flushing, nasal congestion, dyspepsia, impaired vision, cyanopsia
Acute angle closure glaucoma, ventricular arrhythmias, severe hypotension, MI, stroke, priapism
181
Contraindications: T replacement therapy
PrCa, BrCa, erythrocytosis, unstable CHF, severe untreated sleep apnea
182
Testosterone -> ? -> Estrogen
Aromatase
